Development and validation of a novel scoring system for acute ischemic stroke

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke (AIS) diagnosis and management require accurate assessment of intracranial artery occlusions.
• Computed tomographic angiography (CTA) is crucial for visualizing these occlusions.
• Existing scoring systems may not comprehensively cover all affected arterial territories.

Purpose of the Study:

• To evaluate the clinical utility of the Artery Occlusion Image Score (AOIS), a novel CTA-based metric.
• To assess AOIS's accuracy in reflecting the severity of main intracranial artery occlusive changes.
• To compare AOIS performance against established scores like BATMAN and CBS for predicting patient prognosis.

Main Methods:

• A cohort of 439 acute ischemic stroke patients was analyzed.
• Patients were categorized into anterior circulation infarcts (ACI), posterior circulation infarcts (PCI), and combined ACI+PCI groups.
• Receiver-operating characteristic (ROC) curve analysis was used to compare AOIS sensitivity and specificity against BATMAN, CBS, and NIHSS.

Main Results:

• AOIS demonstrated high sensitivity and specificity in both ACI (86.3%, 85.0%) and PCI (88.9%, 90.0%) groups.
• AOIS outperformed CBS in predicting prognosis for ACI and BATMAN for PCI.
• A significant positive correlation was observed between AOIS and NIHSS in the ACI+PCI group (Spearman's ρ = 0.602, P < .001).
• AOIS scoring time was comparable to CBS and BATMAN.

Conclusions:

• AOIS is a convenient and reliable tool for guiding treatment and predicting outcomes in AIS patients with ACI and/or PCI.
• It is the first CTA-based scoring system to encompass both anterior and posterior circulations.
• AOIS offers a comprehensive evaluation for patients with concurrent involvement of both circulations.